Over the last two to three years, police and healthcare providers say they’ve watched a heroin epidemic take hold in rural, economically depressed areas of Western Massachusetts. Franklin County has been hit particularly hard.

“People’s lives are destroyed. If they were on track for school or college, that’s long gone,” said Ruth Potee, a primary care doctor in Greenfield who estimates at least 10 percent of her patients are addicted to heroin. “You read the obituaries in any of the local papers, and if you’ve got a person dying under the age of 40, [the majority] are overdoses.”

Most of Potee’s patients start with prescription painkillers in the opiate family, such as oxycodone. Within about six months they move onto heroin, which is cheaper and easier to get. “If you’re 19, you can’t walk into a liquor store and get a six pack of beer,” she said. “But you can walk down the street in most neighborhoods, in most of our Western Massachusetts counties, and get heroin.”

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Heroin today is more potent than it used to be. “It’s so incredibly pure. People describe the delicious high that you get unlike any previous drug available,” Potee said. “It’s very different from the heroin we had in the ’60s, ’70s, and ’80s.”

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But Potee says there aren’t nearly enough doctors prepared to treat addiction in Western Massachusetts, compared with the Boston area. She is one of two general practitioners in Franklin County with a license to prescribe the anti-addiction drug buprenorphine (tradename Suboxone) an FDA-approved medication that, like methadone, blocks the opiate receptors in the brain and helps suppress cravings and withdrawal symptoms. Some nonprofit treatment centers also dispense Suboxone, including CleanSlate – which sees approximately 500 addicted patients in its Greenfield location.

Potee estimates that Suboxone has a 70 percent success rate in treating addiction. This fall she plans to start treating addicts in the North Quabbin region, which includes Athol, Orange, Salem, and Wendell, where she knows of no Suboxone-licensed physician.

But Suboxone only works for those ready to get better, Potee said. Some addicts only get to that point after going to jail. Others need two or three stints in rehab before they develop the resolve to quit. Meanwhile, she continues to see patients in her primary care practice who are addicted but refuse any treatment. Three of them died of overdoses last year.